Method and composition for treating cystitis

ABSTRACT

A medicament for treating cystitis and a method of treatment are provided. An agent to repair the damaged glycosaminoglycan (“GAG”) layers lining the urothelium, noted in cystitis, such as pentosan polysulfate, hyaluronic acid, chondroitin, etc., is provided in a liposomal carrier. Cystitis is treated by intravesically administering to a patient a therapeutically effective dose of the medicament.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims priority to and the benefit of U.S.Provisional Application Ser. No. 61/612,515 filed on Mar. 19, 2012, theentire content of which is incorporated herein by reference.

FIELD

The invention relates to methods of treatment and pharmaceuticalcompositions for treating various forms of cystitis, in particular theuse of liposomal agents as nanocarriers for urothelial restorativetherapy in cystitis.

BACKGROUND

Interstitial Cystitis (IC), also known as Interstitial Cystitis/ BladderPain Syndrome (IC/PBS) is a chronic, severely debilitating, painfulcondition due to inflammation of the tissues of the bladder wall. Thecause is unknown. Symptoms include pelvic pain and pressure, urinaryfrequency, burning and urgency, and painful intercourse.

IC/BPS is frequently misdiagnosed as a urinary tract infection. Patientsoften go years without a correct diagnosis. On average, there is about a4-year delay between the time the first symptoms occur and the diagnosisis made. The condition is usually diagnosed by ruling out otherconditions (such as sexually transmitted disease, bladder cancer, andbladder infections). Testing for IC/BPS is not always reliable. The KCltest, also known as the potassium sensitivity test, uses a mildpotassium solution to test the integrity of the bladder wall.

The condition generally occurs around age 30 to 50, although it has beenreported in younger people. Women are 10 times more likely to haveIC/BPS than men. Studies reveal that as many as 3 to 8 million Americanssuffer from IC/BPS. The condition is associated with depression,emotional trauma, and other syndromes such as fibromyalgia,endometriosis, and irritable bowel syndrome. Advanced cases may revealulcers and erosions in the bladder lining with ultimate scarring andshrinkage of the bladder.

The cause of IC/BPS is unknown. Theories have included neurologic,allergic, autoimmune, toxic exposure, genetic, abnormal mast cells, andpsychological. It appears that most patients suffer from a deficiency ofthe protective glycosaminoglycan (GAG) layer of the inner bladder lining(urothelium). This results in increased permeability of the underlyingsubmucosal tissues with subsequent tissue destruction.

Other forms of cystitis are also known, including hemorrhagic cystitis(including radiation- and chemical-induced cystitis), traumaticcystitis, and chronic cystitis caused by an infectious agent. In eachcase, the condition is associated with inflammation of the urotheliallining and loss of the glycosaminoglycan (“GAG”) layer to some extent.This causes irritable voiding symptoms including pain, frequency, andurgency. Some of the most common forms of cystitis include:

Radiation Cystitis. This form of hemorrhagic cystitis can be disablingand potentially lethal. Radiation-induced degeneration andde-vascularization of the normal urothelium can occur even 10 yearsafter ionizing radiation is delivered to the pelvis for the treatment ofmalignancy. Radiation cystitis can be treated with limited effectivenessand is usually incurable.

Chemical Cystitis. This form of hemorrhagic cystitis is often related tothe administration of chemotherapy (cytoxan or ifosfamide). These agentscan produce acrolein, which has an erosive effect on the urothelium andcan cause significant irritative symptoms and even increase the risk fortransitional cell carcinoma. Chemical cystitis can sometimes heal on itsown.

Chronic Cystitis. Usually bacterial in origin (but can be viral),chronic cystitis is caused by infection. Bacterial infections make thebladder pre-disposed to recurrent infections and severe sensitivity withirritative symptoms. Symptoms can persist for some time even after theactive infection is eradicated by appropriate antibiotic therapy.

There is no cure for interstitial cystitis, and there are no standard orconsistently effective treatments. Treatment is currently based on trialand error and can include opioids, pain inhibitors, antidepressants,vistaril, detrussor relaxants, bladder hydrodistension, bladderinstillations (in which a solution is introduced into the bladder via acatheter), biofeedback, dietary modification, and even surgery toenlarge or remove the bladder. Instillations are intravesical treatmentstypically performed with a number of different combination “cocktails”that may include dimethyl sulfoxide (DMSO), steroids, heparin,chlorpactin, lidocaine, sodium hyaluronate (cystistat), chondroitin(uracyst), and sodium bicarbonate.

Elmiron® (pentosan polysulfate) is the only medication taken by mouththat is specifically approved for treating IC. There have also beenreported attempts in the literature at intravesical instillation ofElmiron®. The KCl test has been determined to be helpful in predictingthe success of Elmiron®.

Pentosan polysulfate (also known as sodium pentosan polysulfate andpentosan polysulfate sodium) is related to the low molecular weightheparin class of molecules. The official Elmiron® website(www.orthoelmiron.com) states that it is not known exactly how Elmiron®works. Preliminary clinical models suggest that the medicine coats thebladder and the pentosan polysulfate repairs damaged glycosaminoglycan(GAG) layers lining the urothelium. In vitro data suggest that it mayprovide an anti-inflammatory effect in patients with IC. Pentosanpolysulfate shows beneficial effects in a proportion of patients with ICin terms of the improvement of a patient's overall condition and therelief of pain, and it is a generally well tolerated therapy. (Pentosanpolysulfate: a review of its use in the relief of bladder pain ordiscomfort in interstitial cystitis. Anderson V R, Perry C M, Drugs.2006;66(6):821-35.) Although most controlled trials suggest a positiveeffect of oral Elmiron®, some studies have shown little benefit overplacebo. It is the only U.S. FDA-approved oral treatment for the reliefof bladder pain or discomfort associated with IC. The usual dose is 100mg taken before or after meals three times per day. A veterinary versionof Elmiron® is available under the trademark Cartrophen Vet®.

When administered orally, Elmiron® has pharmacokinetic limitations, asonly 6% is absorbed and reaches the circulation, and a mean of 6% of anoral dose is excreted in the urine, mostly as desulfated anddepolymerized metabolites. Only a small fraction of the administereddose (mean 0.14%) is recovered as intact drug in urine.

Oral Elmiron® is also associated with several systemic side effects,including hair loss, GI intolerance, headache, rash, sleep disturbance,and vertigo. Rarely, blood thinning can result.

Dr Lowell Parsons, who conducted the original studies on Elmiron®, hasalso studied intravesical Elmiron® instillation. According to the ICnetwork, an online site that provides information about interstitialcystitis, several preliminary research studies that discussed newinstillations were presented at the Bladder Symposium in October 2003,including: #1. Lowell Parsons presented the results for using Elmiron®intravesically. 40 patients were evaluated. 20 received heparin only(40,000 units of heparin) and 20 received Elmiron® (a solution of 100mgoral Elmiron, 80mg lidocaine and 3 cc's of sodium bicarb). 31 subjectshad significant symptom relief. Nine had no change in their symptoms. Inresponse to therapy, there was no significant difference between the twosolutions. While heparin and Elmiron® had equal efficacy in theintravesical therapeutic solution, an advantage of pentosan polysulfateover heparin is its substantially lower cost.

There have been several reports in the literature describing the use ofliposomes to coat the bladder. See, for example, Tyagi, P., et al., LUTS(2009) 1, S90-S93 (proposing that empty liposomes have a therapeuticeffect by forming a coat on the injured urothelium and blockingirritation of submucosal afferent nerves); Lee, W. C., Kaohsiung J MedSci 2011 Oct. 27 (10): 437-40 (reporting on the safety and doseflexibility clinical evaluation of liposomes in patients with IC, anddocumenting improvement in symptom scores and side effects); and Tyagiand Chancellor, BJU Int. 2009 December; 104(11):1689-92 (Epub 2009 Jul.7) (comparing results in rats treated with instillation of liposomesversus intravesical pentosan polysulfate and versus intravesical DMSO.Intravesical liposomes had the most efficacy). Dr. Chancellor and theLipella Company (www.lipella.com) have described the use of intravesicalliposomes to carry the Botulinum toxin into the bladder wall.

Y C Chung et al. in J Urol 2009 October; 182(4):1393-400 reported onintravesical liposomes versus oral pentosan polysulfate for IC. Theyfound intravesical liposomes achieved efficacy similar to that of oralpentosan polysulfate sodium, and concluded that intravesical liposomesappear to be a promising new treatment for interstitial cystitis/painfulbladder syndrome. Some investigators have used empty liposomes to manageIC symptoms and found better results than with instillation of Elmiron®or DMSO. Tyagi P, Hsieh V C, Yoshimura N, Kaufman J, Chancellor M B,“Instillation of liposomes vs dimethyl sulphoxide or pentosanpolysulphate for reducing bladder hyperactivity,” British Journal ofUrology (BJU Int.) 2009 December; 104(11):1689-92. Epub 2009 Jul. 7. Y CChung used empty liposomes and proved superior efficacy to oralElmiron®. Chuang Y C, Lee W C, Lee W C, Chiang P H., J Urol. 2009 Aug.13. Epub ahead of print. doi:10.1016/j.juro.2009.06.024.

Despite substantial efforts by the medical community to treat IC andother forms of cystitis, a truly effective treatment with few sideeffects has remained elusive.

SUMMARY

In a first aspect of the invention, a medicament for treating cystitisis provided and comprises a glycosaminoglycan (“GAG”), such as pentosanpolysulfate, hyaluronic acid, chondroitin, etc., provided in a liposomalcarrier. In a second aspect of the invention, cystitis is treated byintravesically administering to a patient a therapeutically effectivedose of the medicament. While not bound by theory, it is believed thatthe new method of treating cystitis is urothelial restorative therapy,in which the inflammation and degeneration of the bladder urotheliallining is alleviated and the glycosaminoglycan layer of the bladder isrestored.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention will bebetter understood with reference to the following detailed descriptionwhen considered in conjunction with the accompanying drawings wherein:

FIG. 1 is a bar graph showing pelvic urgency frequency (PUF) scores foreight patients treated using medicaments and methods according toembodiments of the present disclosure; and

FIG. 2 is a bar graph showing O'Leary-Sant scores for eight patientstreated using medicaments and methods according to embodiments of thepresent disclosure.

DETAILED DESCRIPTION

Aspects of embodiments of the present disclosure are directed towardimproving drug delivery of a GAG, protecting a GAG molecule, prolongingdwell times of a GAG, and/or allowing for effective urothelialabsorption of a GAG, to overcome drawbacks of current IC treatments suchas inefficient oral absorption of GAGs and relatively rapid washout dueto a hostile proton environment, which diminishes the efficacy ofbarrier restoration therapy.

In a first aspect of the invention, a medicament for treating cystitisis provided and comprises a glycosaminoglycan (“GAG”) in a liposomalcarrier. GAGs, also known as mucopolysaccharides, are long, unbranchedpolysaccharides consisting of a repeating disaccharide unit: a hexose ora hexuronic acid linked to a hexosamine. Both sulfated and unsulfatedforms are known. Nonlimiting examples include chondroitins (e.g.,chondroitin sulfate), dermatans (dermatan sulfate), heparans (heparansulfate), heparins, hyaluronans (hyaluronic acid, hyaluronates),keratans (keratan sulfate), and pentosans (e.g., pentosan polysulfate).Also included are physiologically acceptable acid, base, ester, and saltforms of such compounds, and mixtures thereof. GAGs such as pentosanpolysulfate, hyaluronic acid, chondroitin sulfate, and heparin arepresently used to treat a number of medical conditions.

By “physiologically acceptable acid, base, ester, and salt forms of suchcompounds” is meant a GAG in its acid, base, salt, or ester form,provided that, in the case of a salt form, the counter ion isphysiologically acceptable to a human, and, in the case of esters, theorganic group R in the ester (˜COOR) is a physiologically acceptableorganic group. Esterification of one or more acid groups in a GAGmolecule is accomplished using known organic chemistry techniques, e.g.,reaction with an alcohol (ROH). An acid, base, and/or other catalyst canbe employed to facilitate the reaction, so long as the disaccharidelinkages are maintained.

By “liposomal carrier” is meant a collection or plurality of liposomes.The liposomes can be made of any physiologically suitable phospholipid,glycolipid, derived lipid, and the like. Nonlimiting examples ofsuitable phospholipids include phosphatidylcholine, phosphatidyl-serine,phosphatidic acid, phosphatidylglycerin, phosphatidylethanolamine,phosphatidyl-inositol, sphingomyelin, dicetyl phosphate,lysophosphatidyl choline, and mixtures of such lipids, such as soybeanphospholipids and egg yolk phospholipids, e.g., lecithin. Suitableglycolipids include cerebroside, sulphur-containing lipids, ganglioside,and the like. Suitable derived lipids include choleic acid, deoxycholicacid, and the like.

The liposomal carrier can be formed using any known method for formingliposomes, which can be loaded with a glycosaminoglycan using any knownmethod for loading liposomes with a chemical agent. Water, 70% to 100%alcohol, and similar solvents can be used to dilute the liposomepreparation. Known methods for forming liposomes containing chemicalagents are described, for example, in U.S. Pat. No. 4,235,871 toPapahadjopoulos, et al., and Oral Microbiology and Immunology, 1994, 2:146-153, 30 the disclosures of which are incorporated herein byreference.

In one embodiment, the liposomes have a mean diameter of less than 200nm, preferably less than 80 nm, more preferably less than 50 nm, asdetermined by, e.g., negative staining electron microscopy. In oneembodiment, for example, the liposomes have a mean diameter of about 50to about 200 nanometers. Preparation of a substantially homogeneouspopulation can be accomplished using conventional techniques, such asextrusion through a straight path or tortuous path-type filter Othermethods of treating liposomes to form a homogenous size distributioninclude ultrasonic exposure (sonication), the French press technique,hydrodynamic shearing, homogenization using, for example, a colloid millor Gaulin homogenizer, and microfluidization techniques.Microfluidization is a presently preferred method.

In one embodiment, pentosan polysulfate or other GAG in a homogeneousliposomal carrier is prepared by intermittent homogenizing at 16,000 rpmwith a handheld immersion blender for approximately 2 minutes.

The liposomal carrier according to an embodiment may be homogenized witha suitable amount of the GAG. Any suitable amount of the liposomalcarrier and the GAG may be used. For example, in one embodiment, anamount of the liposomal carrier ranges from about 100 mg to about 300mg. In some embodiments, for example, the amount of the liposomalcarrier ranges from about 100 mg to about 200 mg. In other embodiments,the amount of the liposomal carrier is about 150 mg, for example, inembodiments where the liposomal carrier is used with pentosanpolysulfate (PP) as the GAG. In some embodiments, an amount of the GAGranges from about 300 mg to about 600 mg. In some embodiments, forexample, the amount of the GAG ranges from about 300 mg to about 500 mg.In other embodiments, the amount of the GAG is about 400 mg, forexample, in embodiments where the GAG is pentosan polysulfate (PP). Insome embodiments, a weight ratio of the liposomal carrier to the GAG isin a range of from about 1:6 to about 1:1. For example, in someembodiments the weight ratio of the liposomal carrier to the GAG is in arange of from about 1:5 to about 1:1. In another embodiment, the weightratio of the liposomal carrier to the GAG is in a range of from about1:5 to about 1:2. In another embodiment, the weight ratio of theliposomal carrier to the GAG is in a range of from about 1:3 to about2:5. In another embodiment, the weight ratio of the liposomal carrier tothe GAG is about 1.5:4, for example, in embodiments where the GAG ispentosan polysulfate (PP).

Microfluidization is described, for example, in U.S. Pat. No. 4,533,254to Cook, et al., which is incorporated herein by reference. In oneembodiment of a microfluidization procedure, the liposomal emulsion isforced at high pressure through a small diameter opening and splatteredonto a wall and then collected. In sonication techniques, the rawmaterials for the liposomes, e.g., phospholipids, are combined withchemical agents, placed in a sonicator, and sonicated for a time, at atemperature and at a speed sufficient to obtain liposomes of the desiredsize.

The liposomes can be stored at reduced temperature, e.g., 40° F., untilready for use. In one embodiment, the liposomes, prior toadministration, are treated to protect them against pH changes andmicellization. In one embodiment, the liposomes are lyophilized. Inanother embodiment, the phospholipid (or any other constituent of thelipid wall) is treated with an additive, such as a crosslinking agent,prior to formation of the liposome.

Lyophilization may be accomplished by any method known in the art. Suchprocedures are disclosed, for example, in U.S. Pat. No. 4,880,836 toJanoff, et al., the disclosure of which is incorporated herein byreference. Lyophilization procedures can include the addition of adrying protectant to the liposome suspension to stabilize the liposomesuspension so that the size and content of the liposomes are maintainedduring the drying procedure and through rehydration. Examples of dryingagents include saccharide sugars, such as dextrose, sucrose, maltose,mannose, galactose, raffinose, trehalose lactose, and triose sugars,which can be added in amounts of about 5% to about 20%, moreparticularly, about 10%, by weight of the aqueous phase of the liposomalsuspension. Manitol can be used in conjunction with any of thesaccharides. Lyophilized liposomes can be reconstituted prior to use byadding water, saline, or other physiologically acceptable solvents.

The medicament as described herein may include one or more components inaddition to the GAG and the liposomal carrier (e.g. additives and/orpreservatives). For example, in some embodiments, the medicament furtherincludes one or more components typically used in combination“cocktails” for treating IC, such as dimethyl sulfoxide (DMSO),steroids, heparin, chlorpactin, lidocaine, sodium hyaluronate(cystistat), chondroitin (uracyst), and/or sodium bicarbonate. In someembodiments, for example, the medicament further includes dimethylsulfoxide (DMSO).

A preservative such as BHT, EDTA, urea, albumin, dextran, or polyvinylalcohol can be added to individual packaged doses for office use.Packaging should emphasize sterility but may also be designed to alloweasy homogenization through the opening of the package, which can fittightly around the tip of a hand blender (having, e.g., a 2 inchdiameter steel head) to allow homogenization inside the package prior todispensing. In one embodiment, a convenient port allows aspiration witha piston “catheter tip” syringe for instillation. This can be part of akit. In one embodiment, a kit contains liposomes, separately packagedGAG(s), and a syringe/catheter tip. The GAG(s) can be added to theliposomes and the resulting combination homogenized immediately prior touse, then loaded into the syringe for administration to a patient. Otheringredients, e.g., DMSO, can also be provided in the kit. DMSO has shownsome effectiveness in treating IC.

In a second aspect of the invention, a method of treating cystitis isprovided and comprises intravesically administering a therapeuticallyeffective dose of a glycosaminoglycan (“GAG”) in a liposomal carrier. Asused herein, the term “intravesically” and similar terms refer toadministration of a medicament into the bladder, e.g. by a catheter. Themethod can be used for glycosaminoglycan (GAG) barrier restoration.

GAGs suitable for use in the method of treating cystitis according toembodiments of the present disclosure include those already describedabove with reference to the medicament, including but not limited tochondroitins (e.g. chondroitin sulfate), dennatans (e.g. dermatansulfate), heparans (e.g. heparan sulfate), heparins, hyaluronans (e.g.hyaluronic acid, hyaluronates), keratans (e.g. keratan sulfate), andpentosans (e.g. pentosan polysulfate), in addition to physiologicallyacceptable acid, base, ester, and salt forms of such compounds andmixtures thereof. In some embodiments, the glycosaminoglycan (GAG) ispentosan polysulfate (PP), which has been used safely both orally andintravesically for glycosaminoglycan (GAG) barrier restoration therapy,albeit somewhat ineffectively.

According to embodiments of the present invention, high qualitymulti-lamellar liposomes are used to encapsulate the GAG (e.g. pentosanpolysulfate). In some embodiments, for example, the GAG is encapsulatedaccording to a method suitable for encapsulating a GAG (e.g., accordingto the methods described herein, such as that described in Example 1).

In some embodiments, the GAG is encapsulated in a liposomal carrier, andthe encapsulated GAG is administered to a patient with refractoryinterstitial cystitis. In some embodiments, the GAG is administered in atherapeutically effective dose. For example, in some embodiments, thetherapeutically effective dose ranges from about 300 mg to about 600 mgof the GAG. In some embodiments, for example, the therapeuticallyeffective dose ranges from about 300 mg to about 500 mg of the GAG. Inanother embodiment, the therapeutically effective dose is about 400 mgof the GAG, for example, in embodiments where the GAG is pentosanpolysulfate (PP).

Upon instillation, patients are instructed to retain the compound atleast 30 minutes if possible. During this retention period, patients areinstructed to turn 90 degrees every 5 minutes with exam table reversetrendelenberg (tilted head down approximately 30 degrees) and withreverse trendelenberg (tilted head up approximately 30 degrees).

In some embodiments, the patient receives four or more administrationsor instillations of the encapsulated GAG. The administrations orinstillations may occur biweekly (i.e. every two weeks) such that apatient receives four administrations or instillations over a totalperiod of six weeks, beginning with the first instillation. However, theinstillations can occur over any suitable time frame.

In some embodiments, treating IC patients with medicaments according tothe present disclosure and/or treating IC patients using methodsaccording to the present disclosure, provide the patient with durableand/or sustained relief of the symptoms of IC. In some embodiments, forexample, the durable and/or sustained relief of symptoms lasts forapproximately 6 months or greater.

The following Examples are presented for illustrative purposes only anddo not limit the scope of the invention.

EXAMPLE 1 Preparation of a Medicament Containing a GAG in a LiposomalCarrier

-   1. 2,250 ml. of water (double distilled) is charged to a beaker    (keep cool in ice bath, etc) and a nitrogen sparge is set for at    least 30 minutes.-   2. Add 225 grams of maltose (Sigma M5885) to the water and mix until    dissolved. Keep the nitrogen sparge going. Maintain pH of 4.81 by    adding acetic acid as needed.-   3. In another beaker, 10.59 grams of egg phosphatidylcholine(EPC)    (Sigma or equivalent substitute) is combined with 8.38 ml. of    ethanol (anhydrous, Sigma E3884) and mixed until dissolved. To this    add 67.5 mg. of BHT and mix until dissolved. To this mixture add 400    mg. of pentosan polysulfate, and mix until dissolved. Use the    remaining 4.19 ml. of ethanol to rinse any remaining contents of the    weighing container into the mixture.-   4. Draw the ethanol solution into a 10 ml. syringe and add to the    maltose solution over 11 minutes with continued nitrogen sparge.    Keep pH<7.0 (goes into Microfluidizer at pH 4.81). Measure. Hand    blade mixture. Keep everything cool at about 1.5 degrees C.-   5. Add to Microfluidizer. Four passes through a M-110Y high-pressure    pneumatic microfluidizer (Microfluidics, Newton, Mass.), with the    pressure set at 16,000 psi. Keep the Microfluidizer homogenization    chamber cooled (ice bath or other coolant) as the passage through    the small aperture causes a microsecond of heating to occur.

Ingredient Quantity Scale-up EPC: 10.59 g 107.57 g Maltose: 225 g 2,286grams Ethanol: 12.57 ml 127.69 ml. BHT: 67.5 mg 685.7 ml Pentosanpolysulfate 400 mg 4,063 mg (USP) Water: 2,250 ml 22,856 ml

A multiplier of 10.158 is used for the scale-up.

The above protocol can be used to encapsulate up to about 2 grams (2,160mg) of a GAG and one or more additional components.

Pentosan polysulfate can be obtained by opening capsules of Elmiron® andremoving the contents. Each capsule contains 100 mg of pentosanpolysulfate, and various excipients. The contents of four such capsulescan be used to prepare a medicament containing 400 mg of pentosanpolysulfate.

At 16,000 psi in the microfluidizer, localized heating can occur. Themelting point of maltose is 102-103° C., so it is important to cool themixing chamber using an ice bath or other cooling means.

EXAMPLE 2 Instillation of GAG-Containing-Liposomes in an InterstitialCystitis Patient

100 cc of liposomes containing pentosan polysulfate are placed in a 500cc metal mixing bowel on a sterile field, and 100cc of sterile water areslowly added as the mixture is homogenized over 1-2 minutes at 16000rpm. The solution is then slowly instilled through a silicone catheterinto a patient's bladder using a 70 cc piston syringe with a “cathetertip.”

IC patients treated with an instillation containing Elmiron® inliposomes were able to retain the compound in their bladders for up to45 minutes. In contrast, IC patients treated with standard intravesicalinstillations of “cocktails” containing one or more of heparin,bicarbonate, DMSO, lidocaine, etc., and no liposomes, could oftentolerate the instillations for no more than 10 to 15 minutes.Preliminary studies on five patients treated with anElmiron®-in-liposomes medicament showed no negative side effects. Noinfection, pain, bleeding, or system side effects were noted. Allpatients reported improvement in their symptoms as described in theirPelvic Urgency/ Frequency scores and the O'Leary-Sant quality of lifescores. Elmiron®-in-liposomes patients received 1 to 4 treatmentsseparated by 2 weeks.

Example 3. In this example, eight patients were confirmed to haverefractory IC by NIDDK (National Institute of Diabetes and Digestive andKidney Diseases) criteria, and were treated with four biweekly (i.e.every two weeks) intravesical instillations of 400 mg PP, which washomogenized at 16000 rpm with 150 mg of liposomes. The liposomes rangedfrom 50-200 nanometers in diameter. All of the patients had previouslyfailed either oral and/or intravesical PP therapy. The mean number oftreatments that the patients received was 4.6. Overall, the eightpatients received a total of 37 treatments. Subjective outcome toolsincluding O′Leary-Sant scores and Pelvic Urgency Frequency scores wereused to evaluate efficacy of the treatment. The results of theseevaluations are shown in FIG. 1 (Pelvic Urgency Frequency (PUF) scores)and FIG. 2 (O'Leary-Sant scores). In this example, no adverse eventswere recorded. Several of the patients noted durable and sustainedrelief of symptoms for greater than 6 months.

The O′Leary-Sant scores, as used in this example, can be used forevaluating whether a patient has IC or for evaluating patients with ICbefore, during, and/or after a treatment for IC. The O'Leary-Sant testscores include a symptom index and a problem index. The symptom indexmeasures urgency and pain in patients being evaluated for IC. Theproblem index measures a degree to which patients experience eachsymptom. IC is typically diagnosed when a score of greater than 6 isprovided in each symptom index.

The Pelvic Urgency Frequency scores, as used in this example, can alsobe used for evaluating whether a patient has IC or for evaluatingpatients with IC before, during, and/or after a treatment for IC.Additionally, Pelvic Urgency Frequency scores can be used for evaluatingpelvic pain, and particularly, chronic pelvic pain in a patient. PelvicUrgency Frequency scores focus on urgency and frequency issues in IC,and pain and symptoms associated with sexual intercourse. Here, a scoreof greater than 5 indicates approximately a 55% chance of IC, while ascore of greater than 10 indicates approximately a 74% chance of IC.

As can be seen from this example, glycosaminoglycans (GAGs), and inparticular, pentosan polysulfate (PP), are effective in mitigating thesymptoms of IC when delivered intravesically to the urothelium inmulti-lamellar liposomes.

From the preceding disclosure, various modifications and alternateembodiments of the invention will be apparent to persons skilled in theart to which the invention pertains. For example, one or more additionalcomponents can be included in the medicament. In one such embodiment,the medicament contains dimethyl sulfoxide in addition to the liposomescontaining one or more GAG compounds. All such modifications andembodiments are within the scope of the invention, which is limited onlyby the appended claims and equivalents thereof.

What is claimed is:
 1. A method of treating cystitis, comprising: intravesically administering a therapeutically effective dose of a glycosaminoglycan (“GAG”) in a liposomal carrier.
 2. A method as recited in claim 1, wherein the GAG is selected from the group consisting of chondroitins, dermatans, heparans, heparins, hyaluronans, keratans, pentosans, physiologically acceptable acid, base, ester, and salt forms of such compounds, and mixtures thereof.
 3. A method as recited in claim 1, wherein the GAG comprises sodium pentosan polysulfate.
 4. A method as recited in claim 1, wherein the GAG comprises hyaluronic acid or a physiologically acceptable ester or salt thereof.
 5. A method as recited in claim 1, wherein the GAG comprises chondroitin sulfate.
 6. A method as recited in claim 1, wherein the liposomal carrier comprises liposomes having a mean diameter of 50 nm or less.
 7. A method as recited in claim 1, wherein the cystitis is interstitial cystitis, infectious cystitis, radiation cystitis, or chemical cystitis.
 8. A method as recited in claim 1, wherein the cystitis is interstitial cystitis.
 9. A method as recited in claim 1, wherein the cystitis is radiation cystitis.
 10. A method as recited in claim 1, wherein the cystitis is chemical cystitis.
 11. A method as recited in claim 1, further comprising co-administering DMSO with the GAG in the liposomal carrier.
 12. A medicament for treating cystitis, comprising a GAG in a liposomal carrier.
 13. A medicament as recited in claim 12, wherein the GAG is selected from the group consisting of chondroitins, dermatans, heparans, heparins, hyaluronans, keratans, pentosans, physiologically acceptable acid, base, ester, and salt forms of such compounds, and mixtures thereof.
 14. A medicament as recited in claim 13, wherein the GAG comprises sodium pentosan polysulfate.
 15. A medicament as recited in claim 13, wherein the GAG comprises hyaluronic acid or a physiologically acceptable ester or salt thereof.
 16. A medicament as recited in claim 13, wherein the GAG comprises chondroitin sulfate.
 17. A medicament as recited in claim 12, wherein the liposomal carrier comprises liposomes having a mean diameter of 50 nm or less.
 18. A medicament as recited in claim 12, further comprising DMSO. 